Survival after surgical treatment of early gastric cancer, surgical techniques, and long-term survival

Abstract

Early gastric cancer (EGC) is well accepted as having a favorable prognosis after surgical treatment. Difference in treatment strategies for EGC between Japan and western countries indicates a need for current information to be evaluated with regard to long-term survival rates of EGC patients throughout the world. To analyze survival rates and recurrence after resection of EGC, we investigated 51 reports in English that each included more than 50 cases of EGC treated by gastrectomy and had been published during the past 12 years (1992-2003). Prevalence of EGC among all gastric cancers was 45%-51% in Japan, but only 7%-28% in western countries. Mean age at diagnosis was less than 60 years in Japan and Korea, but was more than 60 in most of the Western countries. Actuarial and disease-specific 5-year survival rates for EGC were 72%-95.8% and 88%-98.3%, respectively. Those for EGC that were invading the submucosal layer were 71.6%-94.1% and 82%-96.6%, respectively. Those for EGC with lymph node metastasis were 57%-89.1% and 72%-93.5%, respectively. Prevalence of recurrence ranged from 1.0% to 13.8%. Larger clinical series with more EGC cases showed a lower prevalence of recurrence (P=0.531, P=0.0026). Liver and blood-borne distant metastasis represented the predominant pattern of relapse, accounting for over half (54%). Local recurrence and peritoneal dissemination represented 20% and 18% of all recurrences, respectively. Clinicopathological studies have shown lymph node metastasis to be closely related to depth of invasion, size of lesion, histological type, presence of ulcer or ulcer scar, and vessel involvement. Information on these factors is the key to successful treatment of EGC. When sufficient information has been assessed preoperatively, surgeons can select patients for whom less-invasive surgery should not increase the risk of recurrence.

Five-year survival analysis of surgically resected gastric cancer cases in Japan: a retrospective analysis of more than 100,000 patients from the nationwide registry of the Japanese Gastric Cancer Association (2001–2007)

“…For pT1 tumors, hematogenous recurrence represented the predominant mode of recurrence, consistent with other reports [12,13]. When the tumor does not invade the serosa, peritoneal recurrence is rare.…”

Is adjuvant chemotherapy necessary in pT1N1 gastric cancer?

“…The incidence of lymph node metastasis ranges from 10 to 15% in EGC with recurrence rate of 1.4–7.0% [5, 20–23]. In node-positive EGC, recurrence rates are higher (10.6–14.8%) than those of node-negative EGC.…”

Prevalence and Risk Factors of Atrophic Gastritis and Intestinal Metaplasia: A Nationwide Multicenter Prospective Study in Korea

“…Whereas the postoperative 5-year survival rates are 90% to 95% for early gastric cancer (EGC), only 20% to 40% of patients with advanced gastric cancer are expected to survive for 5 years or more 2-4. Moreover, surgery is no more needed in a considerable fraction of patients who are diagnosed with EGC, owing to recent advances in endoscopic resection techniques and technologies.…”